Assigning vs delegating: is there a difference in nursing care?
The RN is responsible for the overall direction of nursing care. The LPN provides care within their scope of practice and under the direction of the RN. The level of communication necessary between the RN and LPN during a shift is determined by the client predictability. As client outcomes become more predictable, the LPN functions with minimal direction, following the plan of care. As client outcomes become less predictable, the RN takes a lead role in the care and gives specific direction to the LPN. This lead role includes supervision of nursing care provided which means consultation, guidance, evaluation and follow-up by the RN at the point of care, for the purpose of overseeing the care which is assigned.
When the RN/LPN team is sharing a client assignment, the following factors must be taken into consideration when determining workload:
* what care requirements are needed for the client,
* who will be responsible for implementing these interventions, and
* how the RN and LPN communicate about the patient's care needs throughout the shift.
Work is divided up using each care team member's skills to the fullest extent, freeing the RN to do the work that only an RN can do. When help is needed, care team members assist each other or reorganize their work plan for the shift. The LPN is responsible for requesting direction from the RN when assistance is required.
Assignment is "the selective designation of specific responsibilities for client care within the legislated scope of practice, role description and employer policies" (NANB, 2003).
In different settings, the work assignment for nursing care is determined by different nursing personnel. For example, it can be done by a nurse manager, team leader, resource nurse, cover nurse or case manager. When assigning clinical responsibilities, many key factors must be considered. Those factors are (1) the care requirements, (2) the competencies and the care provider characteristics, and (3) the practice setting.
Delegation of nursing functions
It is important to note that there is a clear distinction between assigning care and delegating care. Assignment occurs when the required care falls within the scope of practice and within the employing agency's role description and policies.
Delegation is defined as the "formal transference of authority to perform a specific function in a selected situation" (CNPS, 2000). Delegation of nursing function occurs when the function is outside the caregiver's scope of practice. This will require that the one delegated to will need to be taught how to perform the desired work. Although nurses are responsible to clients for ensuring safe nursing care, health care facilities are also responsible for authorizing nurses to delegate to other health care workers. Because of agency liability, nursing tasks or procedures cannot be delegated to other health care workers without the presence of the employer's authorization.
When deciding to delegate care, the following factors must be considered:
* the presence of agency policies and protocols that support nurses delegating nursing tasks and procedures (NANB, 2002),
* the complexity and variability of the care needs,
* the level of supervision needed,
* the complexity of the client's condition and how it is expected to change over time,
* the cognitive and technical requirements of nursing care for the client,
* the intensity and range of potential negative outcomes of the care activities, and
* the availability of resources to consult or intervene.
For more information on assignment or delegation, please contact the Nurses Association of New Brunswick at 1-506-458-8731 or 1-800-442-4417 or go to our Web site at www.nanb.nb.ca.
Nurses Association of New Brunswick (2002). Position Statement: Delegated Nursing Tasks and Procedures. Fredericton, NB. Author. http://www.nanb.nb.ca/pdf_e/ Publications/Position_Statements/ POSITION_STATEMENTS_pdf/DELEGATING_ NURSING_TASKS_AND_PROCEDURES_E.pdf
Nurses Association of New Brunswick and Association of New Brunswick Licensed Practical Nurses (2003). Working Together: A Framework for the Registered Nurse and the Licensed Practical Nurse. Fredericton, NB. Author.
http://www.nanb.nb.ca/pdf_e/Publications/ General_Publications/RN-LPN% 20(e)1.pdf
Canadian Nurses Protective Society (CNPS) (2000). Delegation to Other Health Care Workers. Info Law, 9 (2). Ottawa, Ont. Author.
Editor's note: Virgil Guitard in a nursing practice advisor at the Nurses Association of New Brunswick.
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|Title Annotation:||ASK A PRACTICE ADVISOR|
|Date:||Mar 22, 2007|
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